CPT 42106
Global 010 ActiveExcision lesion mouth roof
CPT 42106 Billing & Documentation Guide
CPT code 42106 (Excision lesion mouth roof) is classified under Surgery (Digestive) with a global period indicator of 010. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.1, a non-facility practice expense RVU of 5.46, and a malpractice RVU of 0.27, a total non-facility RVU of 7.83 and facility RVU of 4.49. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $269.62, though rates vary from $231.44 to $345.67 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 42106, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 42106 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
10-day global period (minor procedure: pre-op day + procedure + 10 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 2 units of 42106 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 42106
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.1 | 2.1 |
| Practice Expense RVU | 5.46 | 2.12 |
| Malpractice RVU | 0.27 | 0.27 |
| Total RVU | 7.83 | 4.49 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 42106
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $293.34 | $161.33 | $276.04 - $345.67 | 29 |
| Florida | $270.68 | $158.74 | $258.04 - $282.8 | 3 |
| Georgia | $255.02 | $148.59 | $243.56 - $266.47 | 2 |
| Illinois | $263.84 | $156.04 | $250.74 - $274.61 | 4 |
| Michigan | $254.08 | $149.33 | $246.83 - $261.33 | 2 |
| North Carolina | $246.05 | $141.97 | $246.05 - $246.05 | 1 |
| New York | $289.18 | $164.72 | $249.73 - $308.21 | 5 |
| Ohio | $245.74 | $143.88 | $245.74 - $245.74 | 1 |
| Pennsylvania | $259.05 | $149.77 | $246.08 - $272.01 | 2 |
| Texas | $258.45 | $148.62 | $244.48 - $271.22 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 42106
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 42106 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00170 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 42106
What does CPT code 42106 mean? +
CPT code 42106 represents: Excision lesion mouth roof. It's in the Surgery (Digestive) category with a global period of 010.
What is the Medicare reimbursement for CPT 42106? +
The 2026 Medicare national average non-facility payment for CPT 42106 is $269.62. Rates range from $231.44 to $345.67 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 42106? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 42106? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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